Only 13.4% of the target audience uses temporary contraception of any form. To give a comparison, in 1994, the world average of IUD usage was four times that in India, while for female sterilization, it was less than half that in India.
Let us look at the data for contraceptive usage in a slightly different way.
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| There is a very clear skew towards older segments of the population when it comes to contraception usage. Combine this with the fact that the overwhelmingly preferred method of contraception used is sterilization, and a very clear need emerges to promote temporary methods of contraception, if we are to achieve our population growth rate objectives. |
Given that the average age at marriage for Indian women is 19.3 years, this graph is chilling evidence as to why population control measures have failed to achieve their objectives. On the flip side, it also tells us where to focus and where the opportunities lie.
The opportunity
The government and NGOs are the primary drivers for the popularization of birth control and contraception. The current market is characterized by either sluggish demand or a combination of subsidized brands in the rural and low-income areas and high price brands in large towns and cities, with no middle ground. A significant part of the focus in the past has been on sterilization. There is very clearly a case for changing the rules of this game and for intervention and innovation, both from the private and social entrepreneurship sectors as along with the social issues there are clear business opportunities in bringing the rate of population growth down.
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The graph above plots life expectancy at birth against under-5 mortality rate. Note that the x axis (mortality rate) is in an inverse scale. That is lower mortality rates are towards the right. The whole world can be divided into those with high mortality rates and low life expectancy (on the left, Sub-Saharan Africa, for example) and those with high life expectancy and low mortality under 5 rates (like high income OECD countries). Then there are countries like the UAE that have successfully transcended the gap between the two to move from low life expectancy – high under-5 mortality to high life expectancy – low mortality under-5 levels. India, as can be seen from the graph, is attempting to bridge this divide, but still has a long way to go – from mortality rates in the higher seventies to single digit figures and from life expectancy rates in the early sixties to the seventies and beyond. |
If temporary contraceptive methods start being used by just 10 percent more of the female population in the reproductive age, that would mean an increase in the market for temporary contraception by 56 million people! Even 1 percent more of the population using temporary contraceptive methods will increase the addressable audience by a not-so-insignificant 5.6 million people!
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| The graph above plots life expectancy against gross national income per capita. Clearly, those on the right-top quadrant are the richer countries that have a good healthcare system. While one can argue whether income comes first or whether higher life expectancy comes first, the inter-linkages between the two cannot be ignored. Better and longer life can lead to more income as well as vice versa. The graph shows that India is attempting to reach the right-top quadrant, but the path is long—per capita incomes have to increase ten-fold. On the other hand, even incremental increases can bring about huge benefits. |
2. Reducing infant mortality
One of the saddest things about India’s high population and growth rate is that it is happening in spite of high infant mortality rates.
Infant mortality is the number per thousand live births of infants below the age of one year who die. I have used another measure—under-5 mortality rate—the mortality rate of infants below the age of 5 years, per thousand live births. India currently has an under-5 mortality rate of 76, down from 115 in 1990 (WHO data). This places us 143rd out of 195 countries in increasing order of infant mortality rates.
Why is reducing under-5 mortality (and infant mortality) important? Keeping aside the moral aspects, a low under-5 mortality rate indicates a robust healthcare system with good pre-natal, natal and post-natal care being available. The mortality rate also has a direct bearing on a number of other social and quality of life indicators like the life expectancy rate
Huge opportunities in the health care sector await being unlocked, particularly in providing quality healthcare in a manner that can easily scale up.
| Replacement fertility rate |
| When population growth becomes zero, we will be at what is known as the replacement fertility rate. This is the theoretical number of children per woman at which the number of newborns equals number of deaths. For India, Population Action International calculated this ratio to be 2.34 in 2006. Against this, The government has a target fertility rate of 2.1, and actual fertility rates are estimated to be 2.72 for 2009. In order to understand these numbers, we need to look at the macro picture of the total population. To take a very simplistic view, Total population = 1.14 billions Sex ratio = 993 Female population = 1.14billions x 993/2000 = 566 millions At current fertility rate, population added over 34 years = 566 x 2.72 = 1540 millions At replacement fertility rate, population added over 34 years = 566 x 2.34 = 1324 millions At government target rates, population added over 34 years = 566 x 2.1 = 1188 millions Note: 34 years come from the fact that reproductive age is considered to be from 15 years to 49 years. This calculation is very simplistic and is for illustration only. Therefore, if we want to achieve population stability, we need to reduce births by 1540-1324= 216 millions over the next 34 years. (Actually, the number will be higher, when we take into consideration declining infant mortality rates). |
3. Increasing life expectancy
India today has an average life expectancy at birth of 64.7 years (2005-10). This splits further into a male life expectancy that is slightly lower at 63.2 and female life expectancy that is slightly higher at 66.4 years. In comparison, the Japanese have a life expectancy of 82.6 and the Vietnamese have a life expectancy of 74.2 years.
Life expectancy in turn is a measure of many other things—quality of healthcare, quality of life, etc. Generally speaking, life expectancy is also a measure of literacy and income levels.
The opportunity
Taking a very simplistic approach, if the average life expectancy of the population were to increase by one year, we are talking of 1.14 billion man-years of markets being created. Given a per capita income of Rs 38,084 in 2008-09, and assuming that figure won’t go down, we are talking of an additional income generation of at least Rs 43,000 billion over one lifespan, or approximately Rs 700 billion every year! If even half of this amount gets spent on goods and services, it is an additional Rs 350 billion (USD 70 billion) a year; not small change by any measure.
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| (Source: Visualization from Gapminder World, powered by Trendalyzer from www.gapminder.org). While the macro picture gives us an overview, the on-ground situation sees huge variations depending on geography, current literacy levels, religion and a plethora of other factors. In this graph, for example, Delhi, which has more than twice the per capita income of Kerala also has twice the infant mortality rate, while Andhra Pradesh, which has a per capita income profile similar to that of Kerala has more than three times the infant mortality rate. Obviously, there is a need to drill further down and to apply the think global, act local philosophy in this context also. |
Action required
The three basic challenges we are talking about are not independent ones. They are interlinked, and changing one of them will end up affecting the other two. So, while we discuss them separately, action would probably need to be combined.
The primary elements of the mix that will provide answers to the population issues are all known. They are literacy, health education, contraception and basic healthcare. There is no rocket science involved in any of these. However, they have been left as intervention areas for the government and for a few NGOs.
As we can see, though, there are huge business benefits (apart from social and quality-of-life benefits) to be had from addressing the population problem. Even small changes to the current situation—as small as one percent difference—can bring into play huge new markets. So, it is high time that businesses attempted to address these issues using innovative, sustainable and productive methods.
A large part of the problem lies at the bottom of the economic pyramid. The current focus of many businesses on this segment to increase their share of the pie provides a context to argue for businesses to start addressing and finding sustainable solutions to basic problems that will in turn end up expanding the pie for everyone.
Note: All calculations in this article have been simplified for easy understanding and should be taken as indicative only.
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written by Sujay Rao Mandavilli, August 31, 2010
1.The central government must set up a coordinator for all high growth states. The coordinator must be appointed by the central government, but will work with state government. District coordinators too must be appointed to prepare action plans and continuously monitor the situation, make modifications, share ideas, success stories and research success stories in India and abroad. Each district can have volunteers. This must be implemented in addition to the ideas stated above. The coordinator must monitor implementation of SSA, PMGSY, NRHM, NREGS as well. This will help greatly because too many good ideas are implemented only in a very small region. Good practices in one region are not implemented elsewhere. This is the biggest roadblock to the family planning program and the biggest failure of central governments. The coordinator will also advise state governments about good practices in other states.
2.Monetary incentive must be given by both Central and State Governments and there must be a uniform central policy
A hypothetical scheme would be as follows
Sterilization after 2 children Rs x
Sterilization after 2 children (at least 1 girl) Rs 2x
Sterilization after 2 children (both girls) Rs 3x
Sterilization after 1 child Rs 4x
Sterilization after 1 child (girl) Rs 6x
3.Incentives for the girl child
Special incentives for the education of the girl child, for higher education etc. This is being implemented by individual state governments but there is no central government policy
4.Multimedia campaign to spread awareness and explain why population control is important to the county and the region, besides the family. The importance of family planning to the region, to the country and to natural resources must also be explained and we have for too long vacillated between inaction and coercion
5.Catch them young: To explain the benefits. Incorporate Family planning awareness in the SSA
6.Make family planning material available through fair price and ration shops in all villages
7.Roping in leading personalities like film actors and religious leaders to spread the message of family planning
8.Special package for senior citizens in NREGS. This is very important to rein in population growth
9.Special package to corporates and other individuals who wish to contribute to family planning initiatives
10.To encourage adult literacy programs particularly female literacy
written by bkbrao, May 31, 2010
a. No ration card if a person is having more than two,
b No free education beyond two children.
c. With draw railway concessions, LTC,medical facilities etc
Save country first. No political gimmicks in this attitude.
Dr. Rao
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And please no plotics here by politicians